Alternate access sought for children requiring residential mental health treatment

Changes over the last 20 years – most recently, the 2018 federal “Family First Prevention Services Act” – mean that many parents hoping to get residential mental health treatment for their children are forced to go through county child welfare systems because of how that care is funded.

“Today’s bill essentially treats mental health treatment in a residential facility like it would any other condition or any other level of mental health care,” Rep. Jessica Hanson (DFL-Burnsville) told the House Behavioral Health Policy Division Wednesday.

She sponsors HF944, which aims to help children with severe mental health issues voluntarily access residential treatment without causing unnecessary delays and distress to their families.

It was approved as amended 12-0 and referred to the House Human Services Finance and Policy Committee. There is no Senate companion.

“What we’re asking for today is for the state to ‘fill in’ the loss of Title IV-E funds, so families don’t have to go through the child welfare door to receive these services,” Hanson said.

Rep. Jessica Hanson

A fiscal note was not available.

The process of going through the “child protection door” to secure care for children means that families receiving coverage through Medical Assistance or Prepaid Medical Assistance programs can be excluded from the decision-making process surrounding their children’s care and have to deal with letters being sent to relatives looking for alternate caregivers, said Sue Abderholden, executive director of NAMI Minnesota.

Abderholden said parents describe the process as “infuriating,” unhelpful, and unnecessary, and one told her, “These kids need professional help, not babysitting.”

“You are so afraid of being judged when you have done the best that you can. But this is extreme parenting,” Abderholden said. “This is not normal parenting. And by the time you reach this point, you are an emotional and physical wreck.”

The bill would also explicitly clarify that a child’s custodial parent or legal custodian retains both legal custody of their child, as well as decision-making authority when that child is voluntarily entered into residential treatment.

However, it does not improve access for all children, Abderholden said.

Work remains to make sure uninsured people and those with inadequate private insurance can still access sufficient residential mental health treatment.

Questions also remain around the funding changes that would allow for this change.

In written testimony, The Minnesota Association of County Social Service Administrators expressed concern on several topics, including the clinical and financial obligations for counties and the impact on youth requiring out-of-state placement.

“I think this is a needed bill. I am wondering about the fiscal impact of this,” said Rep. Keith Franke (R-St. Paul Park). “There are some issues on how these payment structures are all going to intertwine to get this accomplished properly. So, I want to make sure we’re getting this done right.”